T108. CASE REPORT OF A PATIENT WITH CATATONIA

BACKGROUND: Catatonia is a condition defined by the presence of marked psychomotor features that typically include decreased motor activity, decreased engagement or excessive or peculiar motor activity. It is frequently associated with schizophrenia, but also presents in individuals with mood disorders or other neurological or medical conditions. METHODS: We present the case of a 40 year old single Chinese female with borderline intellectual disability who was working as a sales assistant. She presented to medical services with poor oral intake and 8kg weight loss over two months. There was transient fever over a day with a maximum of 38.1 C. No other physical symptoms were elicited. There was a significant change in behaviour, with gradual decline in oral intake and decreased speech. She became more socially withdrawn and neglected self care, as a result she was unable to continue at work two weeks prior to presentation. There was no reported decreased mood, tearfulness or suicidality. She briefly expressed on different occasions that she was ‘already dead’, ‘lost all her blood’ and thought that food was poisoned. There were no reported hallucinations. Mental state examination revealed a thin Chinese female who was staring blankly into space. She did not establish or maintain eye contact, nor did she respond to verbal or physical stimulation. There was minimal speech. She did not appear depressed. There was no stereotypy, mannerisms, echolalia, echopraxia, waxy flexibility or negativism. Physical examination was unremarkable. Neurological examination in particular was normal. RESULTS: Brain Magnetic Resonance Imaging was unremarkable. Electroencephalogram studies showed bitemporal electrophysiologic abnormalities. Lumbar puncture Results: showed raised protein levels of 1.15G/L. Other investigations were essentially normal. Working diagnosis was presumptive viral encephalitis, with catatonia. For the catatonia, she was treated with lorazepam up to 6mg per day and had gradual improvement in her oral intake, speech and behaviour. She revealed later that she was stressed at work. She did not fulfil criteria for Major Depressive Disorder or Schizophrenia. She was discharged after six weeks of her initial presentation to medical services. DISCUSSION: Catatonia can be the main presenting symptom following psychosocial stress.